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Signs and symptoms of gestational trophoblastic disease

It's important to tell your doctor about any abnormal symptoms you are having during pregnancy. Your doctor may suspect that gestational trophoblastic (jeh-STAY-shuh-nul troh-fuh-BLAS-tik) disease (GTD) is present based on a typical pattern of signs and symptoms.

Complete hydatidiform moles (molar pregnancies)

Most of these signs and symptoms (except for bleeding), are seen less commonly now than in the past because they tend to occur late in the course of the disease. Most women with GTD are now diagnosed early because of the use of blood tests and ultrasound early in pregnancy.

Vaginal bleeding: Almost all women with complete hydatidiform (HY-duh-TIH-dih-form) moles have irregular vaginal bleeding during pregnancy. It occurs a little less often with partial moles. Bleeding typically starts during the first trimester (13 weeks) of pregnancy. Women with GTD often pass blood clots or watery brown discharge from the vagina. Sometimes, pieces of the mole resembling a cluster of grapes become dislodged from the uterus and are discharged through the vagina. This bleeding often leads the doctor to order an ultrasound (discussed later in this section), which leads to the diagnosis of a molar pregnancy.

Anemia: In cases of serious or prolonged bleeding, a woman's body is not able to replace red blood cells as fast as they are lost. This can lead to anemia (low red blood cell counts). Symptoms can include fatigue and shortness of breath, especially with physical activity.

Abdominal swelling: The uterus and abdomen (belly) can get bigger faster in a complete molar pregnancy than they do in a normal pregnancy. Abnormal uterine enlargement occurs in about 1 out 4 women with complete moles but rarely in women with partial moles. This may not be seen early in the pregnancy and is more often present in the second trimester.

Ovarian cysts: HCG (human chorionic gonadotropin [HYOO-mun KOR-ee-AH-nik goh-NA-doh-TROH-pin]), a hormone made by the tumor (see below), may cause fluid-filled cysts to form in the ovaries. These cysts can be large enough to cause abdominal swelling. They only occur with very high levels of HCG. Even though they can become quite large, they usually go away on their own about 8 weeks after the molar pregnancy is removed. Sometimes they can twist on their blood supply (called torsion). This can cause severe pain and is treated with surgery to remove the cyst or a procedure to drain the fluid inside the cyst.

Vomiting: Many women have nausea and vomiting during the course of a typical pregnancy. With GTD, however, the vomiting may be more frequent and severe than normal.

Pre-eclampsia: Pre-eclampsia (toxemia of pregnancy) can occur as a complication of a normal pregnancy (usually in the third trimester). When it occurs earlier in pregnancy (like during the first or early second trimester), it can be a sign of a complete molar pregnancy. Pre-eclampsia may cause problems such as high blood pressure, headache, exaggerated reflexes, swelling in the hands or feet, and too much protein leaking into the urine. It affects a small number of women with complete moles but is rare in women with partial moles.

Hyperthyroidism: Hyperthyroidism (having an overactive thyroid gland) occurs in some women with complete hydatidiform moles. It occurs only in women with very high HCG blood levels. Symptoms of hyperthyroidism can include a rapid heartbeat, warm skin, sweating, problems tolerating heat, and mild tremors (shaking). This occurs in less than 10% of women with complete molar pregnancy.

Partial hydatidiform moles

The signs and symptoms of partial hydatidiform moles are similar to those of complete moles, but often are less severe. These include:

Vaginal bleeding

Low red blood cell count (anemia)

Swelling of the abdomen (belly)

Ovarian cysts

Pre-eclampsia (toxic pregnancy)

Some symptoms that are seen with complete moles, such as frequent vomiting or an overactive thyroid gland, rarely, if ever, occur with partial moles.

Partial moles are often diagnosed after a woman has what is thought to be a miscarriage. The molar pregnancy is found when the uterus is scraped during a suction dilation and curettage (D&C) and the products of conception are looked at under a microscope.

Invasive moles and choriocarcinoma

These more invasive forms of gestational trophoblastic (jeh-STAY-shuh-nul troh-fuh-BLAS-tik) disease (GTD) sometimes develop after a complete mole has been removed. They occur less commonly after a partial mole. Choriocarcinoma (KOR-ee-oh-KAR-sih-NOH-muh) can also develop after a normal pregnancy, ectopic pregnancy (where the fetus grows outside of the uterus, such as inside a fallopian tube), or miscarriage. Symptoms can include:

Bleeding: The most common symptom is vaginal bleeding. Rarely, the tumor grows through the uterine wall, which can cause bleeding into the abdominal cavity and severe abdominal pain.

Infection: In larger tumors, some of the tumor cells may die, creating an area where bacteria can grow. Infection may develop, which can cause vaginal discharge, pelvic cramps, and fever.

Abdominal swelling: Like hydatidiform moles, more invasive forms of GTD can expand the uterus, causing abdominal swelling. HCG, a hormone made by the tumor (see “Blood and urine tests” in the section “How is gestational trophoblastic disease diagnosed?”), may cause fluid-filled cysts (called theca lutein cysts) to form in the ovaries, which can be large and may also contribute to abdominal swelling.

Lung symptoms: The lung is a common site for distant spread of GTD. Spread to the lungs may cause coughing up of blood, a dry cough, chest pain, or trouble breathing.

Vaginal mass: These tumors can sometimes spread to the vagina, which can cause vaginal bleeding or a pus-like discharge. The doctor may also notice a cancerous growth on the vagina during a pelvic exam.

Other symptoms of distant spread: Symptoms depend on where GTD has spread. If GTD has spread to the brain, symptoms can include headache, vomiting, dizziness, seizures, or paralysis on one side of the body. Spread to the liver can cause abdominal pain and yellowing of the skin or eyes (jaundice).

Sometimes, choriocarcinoma doesn’t cause symptoms, but may be suspected because a woman has a positive pregnancy test but no fetus is seen on ultrasound.

Placental site trophoblastic tumors

Placental site trophoblastic tumors (PSTTs) rarely spread to distant sites. More often, they grow into the wall of the uterus

Bleeding: The most common symptom of PSTT is vaginal bleeding. If the tumor grows all the way through the wall of the uterus, it can cause bleeding into the abdominal cavity and severe abdominal pain.

Abdominal swelling: As they grow within the wall of the uterus, PSTTs may cause the uterus to enlarge.

Epithelioid trophoblastic tumors

The most common symptom of an epithelioid (ep-ih-THEE-lee-oyd) trophoblastic tumor (ETT) is vaginal bleeding. Other symptoms will depend on where it has spread. For example, if it has spread to the lung, the patient may cough or have shortness of breath. ETTs have also spread to the intestine, where they can cause abdominal (belly) pain, nausea, and vomiting.

Many of the signs and symptoms of GTD could also be caused by other conditions. Still, if you have any of these, it's important to see your doctor right away so the cause can be found and treated, if needed.